[Federal Register Volume 80, Number 35 (Monday, February 23, 2015)]
[Notices]
[Pages 9499-9501]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-03545]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2015-0005]


Agency Information Collection Activities: Proposed Request and 
Comment Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages requiring clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law 104-13, the 
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice 
includes revisions of OMB-approved information collections and one new 
information collection.
    SSA is soliciting comments on the accuracy of the agency's burden 
estimate; the need for the information; its practical utility; ways to 
enhance its quality, utility, and clarity; and ways to minimize burden 
on respondents, including the use of automated collection techniques or 
other forms of information technology. Mail, email, or fax your 
comments and recommendations on the information collection(s) to the 
OMB Desk Officer and SSA Reports Clearance Officer at the following 
addresses or fax numbers.

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974, Email address: [email protected].
(SSA) Social Security Administration, OLCA, Attn: Reports Clearance 
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: [email protected].

    Or you may submit your comments online through www.regulations.gov, 
referencing Docket ID Number [SSA-2015-0005].
    I. The information collections below are pending at SSA. SSA will 
submit them to OMB within 60 days from the date of this notice. To be 
sure we consider your comments, we must receive them no later than 
April 24, 2015. Individuals can obtain copies of the collection 
instruments by writing to the above email address.

[[Page 9500]]

    1. Data Exchange Request Form--0960-NEW. SSA maintains 
approximately 3,000 data exchange agreements and regularly receives new 
requests from Federal, State, local, and foreign governments, as well 
as private organizations, to share data electronically. SSA engages in 
various forms of data exchanges from Social Security number 
verifications to computer matches for benefit eligibility, depending on 
the requestor's business needs. Section 1106 of the Social Security Act 
(Act) requires we consider the requestor's legal authority to receive 
the data, our disclosure policies, systems' feasibility, systems' 
security, and costs before entering into a data exchange agreement. We 
will use Form SSA-157, Data Exchange Request Form, for this purpose. 
Requesting agencies, governments, or private organizations will use the 
form when voluntarily initiating a request for data exchange from SSA. 
Respondents are Federal, State, local, and foreign governments, as well 
as private organizations seeking to share data electronically with SSA.
    Type of Request: This is a new information collection.

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                                                                                         Average      Estimated
                                                            Number of   Frequency of   burden per   total annual
                 Modality of completion                     responses     response      response       burden
                                                                                        (minutes)      (hours)
----------------------------------------------------------------------------------------------------------------
SSA-157.................................................           60             1            30            30
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    2. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521 documents the information SSA needs to process the 
withdrawal of an application for benefits. A paper Form SSA-521 is our 
preferred instrument for executing a withdrawal request; however, any 
written request for withdrawal signed by the claimant or a proper 
applicant on the claimant's behalf will suffice. Individuals who wish 
to withdraw their applications for benefits complete Form SSA-521, or 
sign the completed form for each request to withdraw. SSA uses the 
information from the SSA-521 to process the request for withdrawal. The 
respondents are applicants for Retirement, Survivors, Disability, and 
Health Insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                        Total
                                                                                         Average      estimated
                 Modality of completion                     Number of   Frequency of   burden per      annual
                                                           respondents    response      response       burden
                                                                                        (minutes)      (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521.................................................       39,000             1             5         3,250
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    3. Statement of Self-Employment Income--20 CFR 404.101, 404.110, 
404.1096(a)-(d)--0960-0046. To qualify for insured status and thus 
collect Social Security benefits, self-employed individuals must 
demonstrate they earned the minimum amount of self-employment income 
(SEI) in a current year. SSA uses Form SSA-766, Statement of Self-
Employment Income, to collect the information we need to determine if 
the individual will have at least the minimum amount of SEI needed for 
one or more quarters of coverage in the current year. Based on the 
information we obtain, we may credit additional quarters of coverage to 
give the individual insured status thus expediting benefit payments. 
Respondents are self-employed individuals who may be eligible for 
Social Security benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                        Total
                                                                                         Average      estimated
                 Modality of completion                     Number of   Frequency of   burden per      annual
                                                           respondents    response      response       burden
                                                                                        (minutes)      (hours)
----------------------------------------------------------------------------------------------------------------
SSA-766.................................................        2,500             1             5           208
----------------------------------------------------------------------------------------------------------------

    4. Request for Workers' Compensation/Public Disability Benefit 
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social 
Security disability payments who are also receiving Worker's 
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about 
their WC/PDB, so the agency can reduce claimants' Social Security 
disability payments accordingly. If claimants provide necessary 
evidence, such as a copy of their award notice, benefit check, etc., 
that is sufficient verification. In cases where claimants cannot 
provide such evidence, SSA uses Form SSA-1709. The entity paying the 
WC/PDB benefits, its agent (such as an insurance carrier), or an 
administering public agency complete this form. The respondents are 
Federal, State, and local agencies, insurance carriers, and public or 
private self-insured companies administering WC/PDB benefits to 
disability claimants.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                        Total
                                                                                         Average      estimated
                 Modality of completion                     Number of   Frequency of   burden per      annual
                                                           respondents    response      response       burden
                                                                                        (minutes)      (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1709................................................      120,000             1            15        30,000
----------------------------------------------------------------------------------------------------------------


[[Page 9501]]

    II. SSA submitted the information collection below to OMB for 
clearance. Your comments regarding the information collection would be 
most useful if OMB and SSA receive them 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than March 25, 2015. Individuals can obtain copies of the OMB 
clearance package by writing to [email protected].
    Application for Mother's or Father's Insurance Benefits--20 CFR 
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. Section 202(g) of 
the Act provides for the payment of monthly benefits to the widow or 
widower of an insured individual if the surviving spouse is caring for 
the deceased worker's child (who is entitled to Social Security 
benefits). SSA uses the information on Form SSA-5-BK to determine an 
individual's eligibility for mother's or father's insurance benefits. 
The respondents are individuals caring for a child of the deceased 
worker who is applying for mother's or father's insurance benefits 
under the Old Age, Survivors, and Disability Insurance program.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                        Total
                                                                                          Average     estimated
                   Modality of completion                      Number of    Frequency    burden per     annual
                                                              respondents  of response    response      burden
                                                                                         (minutes)     (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5-F6 (paper)............................................        1,611            1           15          403
Modernized Claim System (MCS)...............................       26,045            1           15        6,511
MCS/Signature Proxy.........................................       26,044            1           14        6,077
                                                             ---------------------------------------------------
    Total...................................................       53,700  ...........  ...........       12,991
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    Dated: February 18, 2015.
Faye Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-03545 Filed 2-20-15; 8:45 am]
BILLING CODE 4191-02-P